Tuesday, February 7, 2023

Cystoscopy Transurethral Resection Of Prostate

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What To Expect After The Procedure

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After the procedure, a urinary catheter will be in place to drain urine. This urine will probably have blood in it.

While the catheter is in place, some men feel bladder spasms or contractions. The catheter is usually removed the following day. A drip may also be in place overnight to help to flush the blood out of the bladder.

At first, you may experience a burning sensation when urinating, or need to urinate frequently. These symptoms should settle with time.

Your doctor is likely to recommend that you avoid strenuous activity, straining and heavy lifting for 6 to 8 weeks after surgery. It is also important to avoid constipation by eating plenty of fibre and drinking 2 to 3 litres of fluid per day.

How Turp Is Performed

TURP is carried out using a device called a resectoscope, which is a thin metal tube containing a light, camera and loop of wire. This is passed along your urethra until it reaches your prostate, which means no cuts need to be made in your skin.

The loop of wire is then heated with an electric current and used to cut away the section of your prostate causing your symptoms. A thin tube called a catheter is then inserted into your urethra to pump fluid into the bladder and flush away pieces of prostate that have been removed.

General or spinal anaesthesia is used during the procedure so you don’t feel any pain while it’s carried out.

What Are The Alternatives To Turp

If you have an enlarged prostate, there are a number of options, including:

  • do nothing some men will find the symptoms get no worse
  • laser therapy, using heat to remove tissue from the prostate
  • microwave treatment, using microwave energy to shrink the prostate
  • other operations, such as transurethral incision of the prostate or open or retropubic prostatectomy

You should think about the benefits and risks of all approaches.

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Transurethral Incision Of The Prostate

TUIP may be used if you have a smaller prostate but major blockage of the urethra. Instead of cutting and removing tissue, TUIP widens the urethra. The surgeon uses a laser beam or an electrical current to make small cuts in the bladder neck, where the urethra joins the bladder, and in the prostate. This reduces the pressure of the prostate on the urethra and makes urination easier. A catheter is left in your bladder for 1 to 3 days after surgery. The hospital stay is 1 to 3 days.

How The Turp Is Performed

TURP (Trans Urethral Resection of the Prostate) â Dr. Piyush Gadam MS ...

The TURP itself has gone through several improvements over the years, brought on in large part by competitive pressure by lasers used for the same purpose such as the Greenlight laser, or Holmium laser . Now, a TURP is done via continuous flow, using bipolar electrical current. This allows the surgeon to use saline as an irrigant rather than water, and this has dramatically increased our ability to offer a bipolar TURP to patients with larger prostates allowing for longer resection times and far fewer complications. A bipolar TURP is the preferred OR procedure of the surgeons at Urologic Surgeons of Washington, with benefits that far outweigh those provided by the various laser vaporization systems currently marketed.

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What Happens Before Transurethral Resection Of The Prostate

Although TURP doesnt use incisions, you need general anesthesia or spinal anesthesia during the procedure. Your healthcare provider will discuss which anesthesia option is best for you.

To prepare for anesthesia, you may need to stop eating and drinking several hours before your procedure. Tell your healthcare provider about all the medications and supplements you take, including blood thinners. Ask your healthcare provider whether you should stop taking any of them before your procedure.

After Discharge From Hospital:

The blood in the urine may take 2 or 3 weeks to clear completely. You should drink extra fluid over the first week or two after surgery. Drinking 1500ml -2000ml per day is usually satisfactory. Do not drink excessively.

If you do notice an increased amount of blood in the urine, then drink extra water to dilute the urine. Occasionally there is more excessive bleeding, and maybe clots in the urine that make it difficult to pass. If this occurs then please contact our office or present to a hospital emergency department for assessment.

The main benefit should be an improvement in urinary flow. In the first few days to weeks there is likely to be irritative symptoms of frequent voiding and a need to get to the toilet quickly . There can be some discomfort or burning when passing urine for as long as 6 weeks after the operation. It often resolves more quickly than this and usually gradually diminishes.

If you find it is not improving or becomes worse then you could have an infection. Either contact our office or see your GP to organise a urine test.

You should be able to recommence most of your usual activities shortly after surgery. Please avoid heavy lifting or straining for about 4 weeks after surgery. Sexual activity can be recommenced once the bleeding settles.

If you have any concerns after your procedure, then please contact our office and speak to one of our practice nurses.

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What Are The Risks And Complications Of Turp

The main risk is to your sex life.

Some men have problems getting an erection after surgery. For some men, that lasts a few months. In about 1 in 10 men, erectile problems are permanent.

Other problems such as bleeding, infection, frequency of urination and urgency can occur. Occasionally, a man develops urinary incontinence after a TURP.

Its important to talk to your partner and your doctor about the impact this surgery might have on your sex life, and to look at alternatives.

What Is Button Turp

Grossing of Urinary bladder resection specimen ( Cysto-Prostatectomy for Urinary bladder tumor)

Button TURP, also called bipolar cautery vaporization, is a newer, less invasive variation of the procedure. Instead of a wire loop on the end of the scope, the surgeon uses a device with a small, button-shaped tip to vaporize prostate tissue.

Button TURP uses low-temperature plasma energy, instead of heat or electrical energy, to remove prostate tissue. Once the extra tissue is removed, the area around it is sealed off to prevent bleeding.

Button, or bipolar, TURP is an umbrella term for a number of different treatments that aim to achieve the same overall outcome, but with different tools, techniques, or device manufactures.

Any procedure that uses an electrode button with bipolar vaporization is a button procedure. Innovations in the procedure involve modifying the shape of the button or making slight changes to the surgical techniques.

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When Should I See My Healthcare Provider

Contact your healthcare provider if you notice:

  • New urinary symptoms, such as a weak stream or frequent urination.
  • Urine thats bright red or has clots in it.
  • Youre unable to urinate.

A note from Cleveland Clinic

TURP is a safe and effective procedure to treat urinary problems from BPH. However, this procedure may not be your only option. New advances in BPH treatment include nonsurgical, minimally invasive procedures that have a shorter recovery than TURP.

Your healthcare provider may recommend a BPH medication first. If medications dont work well, or if you have side effects to medications, you and your healthcare provider may discuss procedures like TURP to remove excess prostate tissue. The treatment you choose depends on your individual health history and your preferences. Together, you can create a BPH treatment plan that works for your needs and lifestyle.

When To Call The Doctor

  • You have pain in your belly that is not helped with your pain medicines
  • It is hard to breathe
  • You have a cough that does not go away
  • You cannot drink or eat
  • Your temperature is above 100.5°F
  • Your urine has a thick, yellow, green, or milky drainage
  • You have signs of infection
  • Your urine stream is not as strong, or you cannot pass any urine at all
  • You have pain, redness, or swelling in your legs

While you have a urinary catheter, call your provider if:

  • You have pain near the catheter
  • You are leaking urine
  • You notice more blood in your urine
  • Your catheter seems blocked and is not draining urine
  • You notice grit or stones in your urine
  • Your urine smells bad, or it is cloudy or a different color

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What You Need To Know

Prior To The Procedure

  • Prepare for an overnight hospital stay
  • Do not eat after midnight before surgery
  • Follow all other pre-procedure instructions provided by our office

What To Expect

  • Blood in urine should be expected and gradually improves over time
  • Catheterization for a few days
  • Exceptional 93% success rate
  • Up to 7 years of relief

Considerations & Complications

Reducing Your Risk Of Complications

Laparoscopic Vesicovaginal Fistula Repair (VVF)

You can help reduce the chance of certain complications by:

  • following activity, dietary, and lifestyle restrictions and recommendations before surgery and during recovery
  • notifying your doctor immediately of any concerns, such as bleeding, bloody urine, fever, an increase in pain, or a change in urination
  • seeing your doctor as instructed before and after surgery
  • taking your medications exactly as directed
  • telling all members of your care team if you have any allergies

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Other Surgical Procedures For Prostate Disease

Alternative surgical procedures to TURP include:

  • open enucleative prostatectomy this involves making a cut in the abdomen to remove a very enlarged prostate. This is the least common form of surgery. The average hospital stay is seven to 10 days
  • laser TURP a laser is used to remove prostate tissue from the middle part of the prostate, which has the advantage of less bleeding and therefore safer for people on anti-coagulation therapy for other problems, including coronary stents, heart valve or vascular disease
  • transurethral incision of the prostate similar to TURP except that no prostate tissue is taken out. One to three cuts are made in the prostate near the bladder neck to release the ‘ring’ of enlarged tissue and make a larger opening around the urinary tract
  • UroLift® this technique is useful for men for whom medication has not been successful but their prostates are not so enlarged that they need a TURP. It involves the transurethral insertion of staples to separate the lobes of the prostate. It has minimal side effects and preserves ejaculatory and erectile function.

What Happens During Transurethral Resection Of The Prostate

Your healthcare provider performs TURP in a hospital operating room or ambulatory surgery center . The procedure usually takes less than 90 minutes. Youll receive anesthesia so you wont feel any pain.

During your procedure, your healthcare provider:

  • Inserts a rectoscope into your urethra.
  • Examines your prostate and removes excess tissue with a laser or electrical current.
  • Uses fluid to temporarily flush the excess tissue into your bladder.
  • Drains any excess tissue out of your bladder through your urethra.
  • Removes the rectoscope.

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Development Of Benign Prostatic Hyperplasia

Mechanisms of disease

The prostate has been described as the organ of the body most likely to be involved with disease of some sort in men older than 60 years. This statement characterizes any histological evidence of BPH as a disease, which is certainly debatable, but there is no argument that BPH is an extremely common clinical entity.

As the hyperplastic process increases the volume of the prostate, the urethral lumen is compressed, causing outlet obstruction. An enlarged median lobe may cause relatively more severe symptoms than lateral lobe hyperplasia of similar magnitude because it can act as a valve at which increased bladder pressure may actually cause further obstruction. Intravesical extension of the lateral lobes may act in a similar fashion.

It has been known for many years, however, that prostate size alone is not a reliable or accurate predictor of the presence or degree of urinary outlet obstruction. The failure of several purely obstructive therapies, such as prostatic balloon dilatation, and the obvious success of alpha-adrenergic blockers eventually led to the description of BPH as having both a dynamic and a mechanical component.

When a bladder is trying to empty through a blocked outlet from an obstructing prostate gland, the intravesical pressure required to open the bladder neck is increased. The bladder is initially able to produce a higher transitory voiding pressure when required, but loses muscle tone over time.

Proposed causes

What Are The Benefits Risks And Side Effects Of Twja

#23338 Evaluation of Urodynamic findings in patients with history of Transurethral Resection of …

TWJA requires general anesthesia. As with any surgery, anesthesia poses a risk. The procedure takes at least an hour. You will need to use a catheter for about 48 hours after the procedure. You should be able to go home the next day. Men may have fewer sexual side effects after TWJA than a TURP. How it compares to the minimally invasive therapies, which do not impact sexual function, is not known. Because this is a new type of therapy follow-up has not been very long . It is not currently known whether the treatment continues to work long-term or whether patients eventually need to have additional treatment.

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What Happens After Transurethral Resection Of The Prostate

After your procedure is done, you go to a recovery area. Some people stay in the hospital for one to two days after TURP, others might be discharged the same day.

During your hospital stay, you have a catheter in your urethra. The catheter helps ensure that urine flows freely after your surgery. Usually, your healthcare provider removes the catheter before you go home.

What To Expect Afterwards:

You are usually able to eat and drink what you feel like after the surgery. Pain relief is always available however, it is not usual to have significant pain after this procedure. A combination of the surgery and the catheter can cause bladder irritation and sometimes bladder spasm.

After removal of the catheter there will most likely still be some blood in the urine. Once we can see that you are passing urine satisfactorily then you are able to go home.

You will be given pain relief if required and antibiotics if necessary to take home with you.

It is important to be aware of the potential risks associated with this surgery including

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Turp Recovery & Aftercare

There is little pain with a TURP. Blood in the urine is to be absolutely expected, and can occur for up to a month in a limited fashion. Although the catheter can be removed the next day, more typical is for the patient to be sent home with the urinary catheter for a few days. Dr. Engel has his patients take out their own catheters the night before seeing him in the office so that urinary retention can be ruled out.

Offsetting these risks is a higher success rate and more immediate relief. The risks of a TURP are not very high, but since they are higher than an office procedure we usually consider it the procedure to turn to when other remedies have failed. Once done, it is extremely effective and patients usually consider their problem solved. It can take up to three months for the bladder to adjust to urinating without obstruction, which leads to less warning time to get to the bathroom after a TURP, but with time this should resolve.

Due to tissue regrowth patients, on average, will enjoy 7 years of relief with a bipolar TURP.

Immediately After A Prostatectomy

TURP Mentor Laser BPH

After the operation, you can expect that:

  • Nurses will monitor your vital signs.
  • You may be given oxygen for up to 24 hours following surgery.
  • You will probably be given antibiotics to prevent infection.
  • For a day or so, you will have a catheter in your urethra and bladder with a continuous wash-out. This is to prevent blood building up and clotting, which could cause a blockage.
  • If you had an open prostatectomy, your wound will be dressed and you will have a tube draining your abdomen. The tube will be removed after several days.
  • Pain will be managed with injections, tablets or both. Pain is rarely a significant problem following TURP.

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What Are The Benefits Risks And Side Effects Of Holep

No incisions are needed. You will only need to stay 1 night in the hospital. There is very little bleeding. Recovery is rapid. You will need a catheter, but it is usually removed the next day. You may have blood in your urine or frequent or painful urination for a few days. This treatment requires anesthesia. Men having HoLEP have more post-operative stress urinary incontinence compared to the other surgeries, but this improves in about 1 year. As with any surgery, anesthesia poses a risk.

Recovery After The Procedure:

After the surgery, the patient is observed in the recovery area, then prepared for discharge home. The foley catheter will be removed at the discretion of the doctor. It typically remains in place for 24 to 48 hours to help drain urine while the prostate heals. One can expect to be discharged from the hospital the day of surgery or the next day.

After surgery, one can anticipate mild discomfort including slight burning with urination, urgency, and frequency. One may notice a small amount of blood in the urine this should not be cause for alarm as this is part of the healing process. Patients will notice improvements in the urinary symptoms gradually.

Men can expect to return to normal activity approximately 3 days after the TURP procedure. Patients should avoid strenuous exercise, heavy lifting or pushing, and avoid equipment that vibrates for about 2 weeks. These types of activities may aggravate the urogenital region and can cause bleeding.

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